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Nome T, Enriquez B, Nome CG, Tennøe B, Lund CG, Skjelland M, Aamodt AH, Beyer M. Clinical outcome after thrombectomy in patients with MeVO stroke: importance of clinical and technical factors. J Neurol 2024; 271:877-886. [PMID: 37847291 PMCID: PMC10827971 DOI: 10.1007/s00415-023-12025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Whereas high-level evidence has been proven for safety and efficacy of endovascular treatment (EVT) in large vessel occlusion (LVO) stroke, the evidence for EVT in medium vessel occlusion (MeVO) in both sexes and different age groupremains to be answered. The aim of this study was to evaluate the importance of clinical and technical parameters, focusing on sex, age and EVT procedural factors, on functional outcome in primary MeVO (pMeVO) strokes. METHODS 144 patients with pMeVO in the MCA territory from the Oslo Acute Reperfusion Stroke Study (OSCAR) were included. Clinical and radiological data were collected including 90-day mRS follow-up. RESULTS Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 123 patients (84%). Good functional outcome (mRS ≤ 2) at 90-day follow-up was achieved in 84 patients (61.8%). Two or more passes with stent retriever was associated with increased risk of SAH, poor mTICI and poor functional outcome. In average, women had 62 min longer ictus to recanalization time compared to men. Age over 80 years was significantly associated with poor outcome and death. CONCLUSION In pMeVO patients, TICI score and number of passes with stent retriever were the main technical factors predicting mRS ≤ 2. Good clinical outcome occurred almost twice as often in patients under 80 years of age compared to patients over 80 years. Women with MeVO strokes had significant longer time from ictus to recanalization; however, this did not affect the clinical outcome.
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Affiliation(s)
- Terje Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Brian Enriquez
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilie G Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, GliaLab and Letten Centre, University of Oslo, Oslo, Norway
| | - Bjørn Tennøe
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mona Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Bendszus M, Fiehler J, Subtil F, Bonekamp S, Aamodt AH, Fuentes B, Gizewski ER, Hill MD, Krajina A, Pierot L, Simonsen CZ, Zeleňák K, Blauenfeldt RA, Cheng B, Denis A, Deutschmann H, Dorn F, Flottmann F, Gellißen S, Gerber JC, Goyal M, Haring J, Herweh C, Hopf-Jensen S, Hua VT, Jensen M, Kastrup A, Keil CF, Klepanec A, Kurča E, Mikkelsen R, Möhlenbruch M, Müller-Hülsbeck S, Münnich N, Pagano P, Papanagiotou P, Petzold GC, Pham M, Puetz V, Raupach J, Reimann G, Ringleb PA, Schell M, Schlemm E, Schönenberger S, Tennøe B, Ulfert C, Vališ K, Vítková E, Vollherbst DF, Wick W, Thomalla G. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet 2023; 402:1753-1763. [PMID: 37837989 DOI: 10.1016/s0140-6736(23)02032-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent evidence suggests a beneficial effect of endovascular thrombectomy in acute ischaemic stroke with large infarct; however, previous trials have relied on multimodal brain imaging, whereas non-contrast CT is mostly used in clinical practice. METHODS In a prospective multicentre, open-label, randomised trial, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and a large established infarct indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 were randomly assigned using a central, web-based system (using a 1:1 ratio) to receive either endovascular thrombectomy with medical treatment or medical treatment (ie, standard of care) alone up to 12 h from stroke onset. The study was conducted in 40 hospitals in Europe and one site in Canada. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days, assessed by investigators masked to treatment assignment. The primary analysis was done in the intention-to-treat population. Safety endpoints included mortality and rates of symptomatic intracranial haemorrhage and were analysed in the safety population, which included all patients based on the treatment they received. This trial is registered with ClinicalTrials.gov, NCT03094715. FINDINGS From July 17, 2018, to Feb 21, 2023, 253 patients were randomly assigned, with 125 patients assigned to endovascular thrombectomy and 128 to medical treatment alone. The trial was stopped early for efficacy after the first pre-planned interim analysis. At 90 days, endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2·58 [95% CI 1·60-4·15]; p=0·0001) and with lower mortality (hazard ratio 0·67 [95% CI 0·46-0·98]; p=0·038). Symptomatic intracranial haemorrhage occurred in seven (6%) patients with thrombectomy and in six (5%) with medical treatment alone. INTERPRETATION Endovascular thrombectomy was associated with improved functional outcome and lower mortality in patients with acute ischaemic stroke from large vessel occlusion with established large infarct in a setting using non-contrast CT as the predominant imaging modality for patient selection. FUNDING EU Horizon 2020.
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Affiliation(s)
- Martin Bendszus
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; eppdata GmbH, Hamburg, Germany
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Susanne Bonekamp
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research-La Paz University Hospital-Universidad Autonoma de Madrid, Madrid, Spain
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Antonin Krajina
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Angélique Denis
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Franziska Dorn
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Fabian Flottmann
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Mayank Goyal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Christian Herweh
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Silke Hopf-Jensen
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Vi Tuan Hua
- Department of Neurology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Kastrup
- Klinik für Neurologie, Klinikum Bremen Mitte, Bremen, Germany
| | - Christiane Fee Keil
- Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stefan Müller-Hülsbeck
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Nico Münnich
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | - Paolo Pagano
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Panagiotis Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen Mitte, Bremen, Germany; Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabor C Petzold
- Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mirko Pham
- Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volker Puetz
- Department of Neurology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Jan Raupach
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Gernot Reimann
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | | | - Maximilian Schell
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bjørn Tennøe
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Christian Ulfert
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kateřina Vališ
- St Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Vítková
- Department of Neurology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | | | - Wolfgang Wick
- Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Nilsen HY, Jørstad AKL, Ryan SJ, Moe MC, Grimstad K, Aamodt AH, Holmøy T, Jørstad ØK. En kvinne i 60-årene som ikke lenger gjenkjente det hun så. Tidsskr Nor Laegeforen 2023; 143:23-0198. [PMID: 37938009 DOI: 10.4045/tidsskr.23.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Neurological disorders can present with a vast array of visual disturbances. The constellation of symptoms and findings in this patient prompted workup for unusual causes of both stroke and neurodegenerative disorder. CASE PRESENTATION A woman in her sixties presented with visual disturbances, followed by weakness in her right arm and aphasia three days later. Her close acquaintances had suspected progressive cognitive decline during the previous year. CT and MRI showed an occluded left posterior cerebral artery with a subacute occipito-temporal infarction. The finding of extensive white matter lesions and segmental arterial vasoconstriction necessitated further workup of vasculitis and hereditary small vessel disease, which were ruled out. The stroke aetiology was considered to be atherosclerotic intracranial large vessel disease. FDG-PET scan revealed decreased metabolism in the left hemisphere, and cerebrospinal biomarkers had slightly decreased beta-amyloid. The findings were suggestive of early Alzheimer's disease or primary progressive aphasia, but currently inconclusive. INTERPRETATION Based on clinical-anatomical correlation, the patient's visual disturbances, in this case right hemianopsia and object agnosia, were solely related to the stroke and not to a neurodegenerative disorder. Knowledge and interpretation of visual agnosias can in many cases be clinically valuable.
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Affiliation(s)
| | | | | | - Morten Carstens Moe
- Øyeavdelingen, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | - Anne Hege Aamodt
- Nevrologisk avdeling, Oslo universitetssykehus, og, Institutt for nevromedisin og bevegelsesvitenskap, NTNU
| | - Trygve Holmøy
- Nevrologisk avdeling, Akershus universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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4
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Alstadhaug KB, Tronvik E, Aamodt AH. Transient ischemic attack or migraine with aura? Tidsskr Nor Laegeforen 2023; 143:23-0225. [PMID: 37874053 DOI: 10.4045/tidsskr.23.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
Migraine or migraine-like symptoms can contribute to a delayed stroke diagnosis. However, migraine with aura is a common stroke mimic and often the basis for acute thrombolytic therapy. It is probably also the reason why many patients are misdiagnosed with a transient ischemic attack. In this clinical review, we explain the factors that could differentiate a transient ischemic attack from a migraine with aura.
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Abdelhak A, Barba L, Romoli M, Benkert P, Conversi F, D'Anna L, Masvekar RR, Bielekova B, Prudencio M, Petrucelli L, Meschia JF, Erben Y, Furlan R, De Lorenzo R, Mandelli A, Sutter R, Hert L, Epple V, Marastoni D, Sellner J, Steinacker P, Aamodt AH, Heggelund L, Dyrhol-Riise AM, Virhammar J, Fällmar D, Rostami E, Kumlien E, Blennow K, Zetterberg H, Tumani H, Sacco S, Green AJ, Otto M, Kuhle J, Ornello R, Foschi M, Abu-Rumeileh S. Prognostic performance of blood neurofilament light chain protein in hospitalized COVID-19 patients without major central nervous system manifestations: an individual participant data meta-analysis. J Neurol 2023:10.1007/s00415-023-11768-1. [PMID: 37184659 PMCID: PMC10183689 DOI: 10.1007/s00415-023-11768-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND AIMS To investigate the prognostic value of blood neurofilament light chain protein (NfL) levels in the acute phase of coronavirus disease 2019 (COVID-19). METHODS We conducted an individual participant data (IPD) meta-analysis after screening on MEDLINE and Scopus to May 23rd 2022. We included studies with hospitalized adult COVID-19 patients without major COVID-19-associated central nervous system (CNS) manifestations and with a measurement of blood NfL in the acute phase as well as data regarding at least one clinical outcome including intensive care unit (ICU) admission, need of mechanical ventilation (MV) and death. We derived the age-adjusted measures NfL Z scores and conducted mixed-effects modelling to test associations between NfL Z scores and other variables, encompassing clinical outcomes. Summary receiver operating characteristic curves (SROCs) were used to calculate the area under the curve (AUC) for blood NfL. RESULTS We identified 382 records, of which 7 studies were included with a total of 669 hospitalized COVID-19 cases (mean age 66.2 ± 15.0 years, 68.1% males). Median NfL Z score at admission was elevated compared to the age-corrected reference population (2.37, IQR: 1.13-3.06, referring to 99th percentile in healthy controls). NfL Z scores were significantly associated with disease duration and severity. Higher NfL Z scores were associated with a higher likelihood of ICU admission, need of MV, and death. SROCs revealed AUCs of 0.74, 0.80 and 0.71 for mortality, need of MV and ICU admission, respectively. CONCLUSIONS Blood NfL levels were elevated in the acute phase of COVID-19 patients without major CNS manifestations and associated with clinical severity and poor outcome. The marker might ameliorate the performance of prognostic multivariable algorithms in COVID-19.
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Affiliation(s)
- Ahmed Abdelhak
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Lorenzo Barba
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Michele Romoli
- Department of Neuroscience, Neurology Unit, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Pascal Benkert
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Francesco Conversi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London SW7 2AZ, UK
| | - Ruturaj R Masvekar
- Neuroimmunological Diseases Section, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Bibiana Bielekova
- Neuroimmunological Diseases Section, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, 32224, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, 32224, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Roberto Furlan
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Institute of Experimental Neurology, Division of Neuroscience, Vita e Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandra Mandelli
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raoul Sutter
- Department of Acute Medical Care, Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Lisa Hert
- Department of Acute Medical Care, Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Varenka Epple
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Petra Steinacker
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anne Margarita Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Elham Rostami
- Department of Medical Sciences, Uppsala University, Neurosurgery,, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eva Kumlien
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ari J Green
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Kuhle
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Department of Neuroscience, Neurology Unit, S.Maria Delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy.
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Ratajczak-Tretel B, Lambert AT, Al-Ani R, Arntzen K, Bakkejord GK, Bekkeseth HMO, Bjerkeli V, Eldøen G, Gulsvik AK, Halvorsen B, Høie GA, Ihle-Hansen H, Ihle-Hansen H, Ingebrigtsen S, Kremer C, Krogseth SB, Kruuse C, Kurz M, Nakstad I, Novotny V, Næss H, Qazi R, Rezaj MK, Rørholt DM, Steffensen LH, Sømark J, Tobro H, Truelsen TC, Wassvik L, Ægidius KL, Atar D, Aamodt AH. Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study. J Neurol 2023:10.1007/s00415-023-11680-8. [PMID: 37162578 DOI: 10.1007/s00415-023-11680-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study. METHOD The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA2DS2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF. RESULTS In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7. CONCLUSION Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.
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Affiliation(s)
- B Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - K Arntzen
- Department for Neurology, Nordlandssykehuset, Bodø, Norway
| | - G K Bakkejord
- Department for Neurology, Nordlandssykehuset, Bodø, Norway
| | - H M O Bekkeseth
- Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway
| | - V Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - G Eldøen
- Department of Neurology, Molde Hospital, Molde, Norway
| | - A K Gulsvik
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - B Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - G A Høie
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - H Ihle-Hansen
- Stroke Unit, Oslo University Hospital, Ullevål, Oslo, Norway
| | - H Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Gjettum, Norway
| | - S Ingebrigtsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - C Kremer
- Department of Neurology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - S B Krogseth
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway
| | - C Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Herlev, Denmark
| | - M Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - I Nakstad
- Department of Neurology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - V Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - H Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - R Qazi
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - M K Rezaj
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - D M Rørholt
- Department of Neurology, Molde Hospital, Molde, Norway
| | - L H Steffensen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - J Sømark
- Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway
| | - H Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | - T C Truelsen
- Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - L Wassvik
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - K L Ægidius
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - D Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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7
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Avan A, Aamodt AH, Selbaek G, Bovim G, Bassetti CLA, Boon P, Grisold W, Hachinski V. Decreasing incidence of stroke, ischemic heart disease and dementia in Norway, 1990-2019, a Global Burden of Disease Study: An Opportunity. Eur J Neurol 2023. [PMID: 37154405 DOI: 10.1111/ene.15836] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The declining incidence of stroke, ischemic heart disease (IHD) and dementia (the triple threat) in Norway encourages further investigation. We analysed the risks and trends of the three conditions using data from the Global Burden of Disease study (GBD). METHODS We used GBD 2019 estimations for age-, sex-, and risk factor-specific incidence and prevalence of "the triple threat" and their risk factor-attributed deaths and disability combined and their age-standardised rates per 100,000 population in 2019 and their changes during 1990-2019. Data are presented in means and 95% uncertainty intervals (UI). RESULTS In 2019, 71.1 thousand Norwegian were living with dementia, 157.2 thousand with IHD, and 95.2 thousand with strokes. In 2019, there were 9.9 thousand (8.5 to 11.3) new cases of dementia (35.0% increase since 1990), 17.0 thousand (14.6 to 19.6) with IHD (3.6% decrease), and 8.0 thousand (7.0 to 9.1) with strokes (12.9% decrease) in Norway. During 1990-2019, their age-standardised incidence rates decreased significantly; dementia by -5.4% (-8.4 to -3.2), IHD by -30.0% (-31.4 to -28.6), and stroke by -35.3% (-38.3 to -32.2), respectively. There were significant declines in the attributable risks to both ENVIRONMENTAL and behavioural factors in Norway, but contradictory trends for metabolic risk factors during 1990-2019. CONCLUSIONS The risk of "the triple threat" conditions is declining in Norway, despite the increased prevalence. This offers the opportunity to find out why and how and to accelerate their joint prevention through new approaches and the promotion of the National Brain Health Strategy.
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Affiliation(s)
- Abolfazl Avan
- Department of Clinical Neurological Sciences, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Selbaek
- Norwegian National Centre for Ageing and Health, Vestfold, Tønsberg, Norway
| | - Gunnar Bovim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital and University of Bern, Past-President, European Academy of Neurology, Bern, Switzerland
| | - Paul Boon
- Department of Neurology, 4Brain, Institute for Neuroscience, Reference Center for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - Wolfgang Grisold
- World Federation of Neurology, Chester House, Fulham Green, 81-83 Fulham High Street, London, United Kingdom
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
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8
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Alstadhaug KB, Aamodt AH. Etablering av medisinske sannheter. Tidsskr Nor Laegeforen 2023; 143:23-0173. [PMID: 36987899 DOI: 10.4045/tidsskr.23.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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9
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Ratajczak-Tretel B, Lambert AT, Al-Ani R, Arntzen K, Bakkejord GK, Bekkeseth HMO, Bjerkeli V, Eldøen G, Gulsvik AK, Halvorsen B, Høie GA, Ihle-Hansen H, Ingebrigtsen S, Kremer C, Krogseth SB, Kruuse C, Kurz M, Nakstad I, Novotny V, Naess H, Qazi R, Rezaj MK, Rørholt DM, Steffensen LH, Sømark J, Tobro H, Truelsen TC, Wassvik L, Ægidius KL, Atar D, Aamodt AH. Underlying causes of cryptogenic stroke and TIA in the nordic atrial fibrillation and stroke (NOR-FIB) study - the importance of comprehensive clinical evaluation. BMC Neurol 2023; 23:115. [PMID: 36944929 PMCID: PMC10028765 DOI: 10.1186/s12883-023-03155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cryptogenic stroke is a heterogeneous condition, with a wide spectrum of possible underlying causes for which the optimal secondary prevention may differ substantially. Attempting a correct etiological diagnosis to reduce the stroke recurrence should be the fundamental goal of modern stroke management. METHODS Prospective observational international multicenter study of cryptogenic stroke and cryptogenic transient ischemic attack (TIA) patients clinically monitored for 12 months to assign the underlying etiology. For atrial fibrillation (AF) detection continuous cardiac rhythm monitoring with insertable cardiac monitor (Reveal LINQ, Medtronic) was performed. The 12-month follow-up data for 250 of 259 initially included NOR-FIB patients were available for analysis. RESULTS After 12 months follow-up probable stroke causes were revealed in 43% patients, while 57% still remained cryptogenic. AF and atrial flutter was most prevalent (29%). In 14% patients other possible causes were revealed (small vessel disease, large-artery atherosclerosis, hypercoagulable states, other cardioembolism). Patients remaining cryptogenic were younger (p < 0.001), had lower CHA2DS2-VASc score (p < 0.001) on admission, and lower NIHSS score (p = 0.031) and mRS (p = 0.016) at discharge. Smoking was more prevalent in patients that were still cryptogenic (p = 0.014), while dyslipidaemia was less prevalent (p = 0.044). Stroke recurrence rate was higher in the cryptogenic group compared to the group where the etiology was revealed, 7.7% vs. 2.8%, (p = 0.091). CONCLUSION Cryptogenic stroke often indicates the inability to identify the cause in the acute phase and should be considered as a working diagnosis until efforts of diagnostic work up succeed in identifying a specific underlying etiology. Timeframe of 6-12-month follow-up may be considered as optimal. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02937077, EudraCT 2018-002298-23.
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Affiliation(s)
- B Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Postboks 300, Grålum, 1714, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - A Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Postboks 300, Grålum, 1714, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - K Arntzen
- Department for Neurology, Nordlandssykehuset, Bodø, Norway
| | - G K Bakkejord
- Department for Neurology, Nordlandssykehuset, Bodø, Norway
| | - H M O Bekkeseth
- Lillehammer Hospital, Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | - V Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - G Eldøen
- Department of Neurology, Molde Hospital, Molde, Norway
| | - A K Gulsvik
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - B Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - G A Høie
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - H Ihle-Hansen
- Stroke Unit, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Internal Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Gjettum, Norway
| | - S Ingebrigtsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - C Kremer
- Department of Neurology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - S B Krogseth
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway
| | - C Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Herlev, Denmark
| | - M Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - I Nakstad
- Drammen Hospital, Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway
| | - V Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - H Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - R Qazi
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - M K Rezaj
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - D M Rørholt
- Department of Neurology, Molde Hospital, Molde, Norway
| | - L H Steffensen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - J Sømark
- Lillehammer Hospital, Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | - H Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | - T C Truelsen
- Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - L Wassvik
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - K L Ægidius
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - D Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - A H Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Neuromedicine and Movement science, The Norwegian University of Science and Technology, Trondheim, Norway
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10
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Enriquez BAB, Nome T, Nome CG, Tennøe B, Lund CG, Beyer MK, Skjelland M, Aamodt AH. Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis. BMC Neurol 2023; 23:82. [PMID: 36849925 PMCID: PMC9969668 DOI: 10.1186/s12883-023-03127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The endovascular treatment procedure in tandem occlusions (TO) is complex compared to single occlusion (SO) and optimal management remains uncertain. The aim of this study was to identify clinical and procedural factors that may be associated to efficacy and safety in the management of TO and compare functional outcome in TO and SO stroke patients. METHODS This is a retrospective single center study of medium (MeVO) and large vessel occlusion (LVO) of the anterior circulation. Clinical, imaging, and interventional data were analyzed to identify predictive factors for symptomatic intracranial hemorrhage (sICH) and functional outcome after endovascular treatment (EVT) in TO. Functional outcome in TO and SO patients was compared. RESULTS Of 662 anterior circulation stroke patients with MeVO and LVO stroke, 90 (14%) had TO. Stenting was performed in 73 (81%) of TO patients. Stent thromboses occurred in 8 (11%) patients. Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 82 (91%). SICH occurred in seven (8%). The strongest predictors for sICH were diabetes mellitus and number of stent retriever passes. Good functional clinical outcome (mRS ≤ 2) at 90-day follow up was similar in TO and SO patients (58% vs 59% respectively). General anesthesia (GA) was associated with good functional outcome whereas hemorrhage in the infarcted tissue, lower mTICI score and history of smoking were associated with poor outcome. CONCLUSIONS The risk of sICH was increased in patients with diabetes mellitus and those with extra stent-retriever attempts. Functional clinical outcomes in patients with TO were comparable to patients with SO.
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Affiliation(s)
| | - Terje Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
| | - Cecilie G. Nome
- grid.55325.340000 0004 0389 8485Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Tennøe
- grid.55325.340000 0004 0389 8485Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Christian G. Lund
- grid.55325.340000 0004 0389 8485Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K. Beyer
- grid.55325.340000 0004 0389 8485Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Skjelland
- grid.55325.340000 0004 0389 8485Department of Neurology, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Hege Aamodt
- grid.55325.340000 0004 0389 8485Department of Neurology, Oslo University Hospital, Oslo, Norway
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11
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Tancin Lambert A, Ratajczak-Tretel B, Al-Ani R, Arntzen K, Bakkejord GK, Bekkeseth HMO, Bjerkeli V, Eldøen G, Gulsvik AK, Halvorsen B, Høie GA, Ihle-Hansen H, Ihle-Hansen H, Ingebrigtsen S, Johansen H, Kremer C, Krogseth SB, Kruuse C, Kurz M, Nakstad I, Novotny V, Naess H, Qazi R, Rezai MK, Rørholt DM, Steffensen LH, Sømark J, Tobro H, Truelsen TC, Wassvik L, AEgidius KL, Pesonen M, de Melis M, Atar D, Aamodt AH. Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study. Eur J Neurol 2023; 30:1352-1363. [PMID: 36786305 DOI: 10.1111/ene.15746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND PURPOSE There are currently no biomarkers to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF. METHODS Eligible CS and cryptogenic transient ischaemic attack patients underwent 12-month monitoring with ICMs, clinical follow-up and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n = 74) during monitoring and those without AF (n = 185). Receiver operating characteristic curves were created. Biomarkers reaching area under the receiver operating characteristic curve ≥ 0.7 were dichotomized by finding optimal cut-off values and were used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models. RESULTS B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase, D-dimer and high-sensitivity cardiac troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached the predefined area under the curve level, 0.755 and 0.725 respectively. Optimal cut-off values were 33.5 ng/l for BNP and 87 ng/l for NT-proBNP. Regression analysis showed that NT-proBNP was a predictor of AF in both unadjusted (odds ratio 7.72, 95% confidence interval 3.16-18.87) and age- and sex-adjusted models (odds ratio 4.82, 95% confidence interval 1.79-12.96). CONCLUSION Several clinically established biomarkers were associated with AF. NT-proBNP performed best as AF predictor and could be used for selecting patients for long-term monitoring with ICMs.
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Affiliation(s)
- Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Riadh Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | | | | | | | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Hege Ihle-Hansen
- Department of Neurology, Stroke Unit, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Gjettum, Norway
| | | | - Henriette Johansen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christine Kremer
- Department of Neurology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Christina Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Herlev, Denmark
| | - Martin Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Ingvild Nakstad
- Department of Neurology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Vojtech Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Rehman Qazi
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Mehdi Kallaj Rezai
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Jesper Sømark
- Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway.,Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Håkon Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | | | - Lejla Wassvik
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Maiju Pesonen
- Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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12
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Beghi E, Moro E, Davidescu EI, Popescu B, Grosu O, Valzania F, Cotelli MS, Kiteva‐Trenchevska G, Zakharova M, Kovács T, Armon C, Brola W, Yasuda CL, Maia LF, Lovrencic‐Huzjan A, de Seabra MML, Avalos‐Pavon R, Aamodt AH, Meoni S, Gryb V, Ozturk S, Karadas O, Krehan I, Leone MA, Lolich M, Bianchi E, Rass V, Helbok R, Bassetti CLA. Comparative features and outcomes of major neurological complications of COVID-19. Eur J Neurol 2023; 30:413-433. [PMID: 36314485 PMCID: PMC9874573 DOI: 10.1111/ene.15617] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations. METHODS The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors. RESULTS By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome. CONCLUSIONS Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.
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Affiliation(s)
- Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Elena Moro
- Centre Hospitalier Universitaire de Grenoble, Service de Neurologie, Grenoble Institute of NeurosciencesGrenoble Alpes UniversityGrenobleFrance
| | - Eugenia Irene Davidescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania and Department of Clinical Neurosciences“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Bogdan Ovidiu Popescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania and Department of Clinical Neurosciences“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Oxana Grosu
- Diomid Gherman Institute of Neurology and NeurosurgeryChișinăuMoldova
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | | | | | | | - Carmel Armon
- Tel Aviv University School of Medicine and Shamir (Assaf Harofeh) Medical CenterTel AvivIsrael
| | - Waldemar Brola
- Department of Neurology, Specialist Hospital Konskie, Collegium MedicumJan Kochanowski UniversityKielcePoland
| | - Clarissa Lin Yasuda
- CEPID BRAINN ‐ Brazilian Institute of Neuroscience and Neurotechnology and University of CampinasCampinasBrazil
| | - Luís F. Maia
- Neurology Department Hospital Santo António – CHUPPortoPortugal
| | | | - Mafalda Maria Laracho de Seabra
- Department of NeurologyCentro Hospitalar Universitário de São João, E.P.EPortoSpain
- Cardiovascular I&D Unit, Portugal Department of Clinical Neurosciences and Mental HealthFaculty of Medicine University of PortoPortoPortugal
| | - Rafael Avalos‐Pavon
- Neurology Service, Facultad de MedicinaUniversidad Autonoma de San Luis Potosi. Hospital CentralSan Luis PotosiMexico
| | | | - Sara Meoni
- Centre Hospitalier Universitaire de Grenoble, Service de Neurologie, Grenoble Institute of NeurosciencesGrenoble Alpes UniversityGrenobleFrance
| | - Victoria Gryb
- Department of Neurology and NeurosurgeryIvano‐Frankivsk National Medical UniversityIvano‐FrankivskUkraine
| | - Serefnur Ozturk
- Selcuk University Faculty of MedicineDepartment of NeurologyKonyaTurkey
| | - Omer Karadas
- University of Health ScienceGulhane School of Medicine, Neurology DepartmentAnkaraTurkey
| | - Ingomar Krehan
- Department of NeurologyKepler University HospitalLinzAustria
| | | | | | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Verena Rass
- Neurocritical Care Unit, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Raimund Helbok
- Neurocritical Care Unit, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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Ratajczak-Tretel B, Tancin Lambert A, Al-Ani R, Arntzen K, Bakkejord GK, Bekkeseth HMO, Bjerkeli V, Eldøen G, Gulsvik A, Halvorsen B, Høie GA, Ihle-Hansen H, Ihle-Hansen H, Ingebrigtsen S, Johansen H, Kremer C, Krogseth SB, Kruuse C, Kurz M, Nakstad I, Novotny V, Næss H, Qazi R, Rezaj MK, Rørholt DM, Steffensen LH, Sømark J, Tobro H, Truelsen TC, Wassvik L, Ægidius KL, Atar D, Aamodt AH. Atrial fibrillation in cryptogenic stroke and TIA patients in the nordic atrial fibrillation and stroke The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results. Eur Stroke J 2022; 8:148-156. [PMID: 37021182 PMCID: PMC10069172 DOI: 10.1177/23969873221123122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Secondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians. Patients and methods: Prospective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection. Results: ICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p < 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p < 0.001) and admission NIHSS (median 2 vs 1; p = 0.001); and more often hypertension ( p = 0.045) and dyslipidaemia ( p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%. Discussion and conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units.
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Affiliation(s)
- B Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - K Arntzen
- Department for Neurology, Nordlandssykehuset, Bodø, Norway
| | - GK Bakkejord
- Department for Neurology, Nordlandssykehuset, Bodø, Norway
| | - HMO Bekkeseth
- Department of Neurology, Lillehammer Hospital, Innlandet Hospital Trust, Lillehammer, Norway
| | - V Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - G Eldøen
- Department of Neurology, Molde Hospital, Molde, Norway
| | - A Gulsvik
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - B Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - GA Høie
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - H Ihle-Hansen
- Ullevål, Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - H Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Gjettum, Norway
| | - S Ingebrigtsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - H Johansen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - C Kremer
- Department of Neurology, Department of Clinical Sciences Lund University, Skåne University Hospital, Malmö, Sweden
| | - SB Krogseth
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway
| | - C Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Herlev, Denmark
| | - M Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - I Nakstad
- Department of Neurology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - V Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - H Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - R Qazi
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - MK Rezaj
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - DM Rørholt
- Department of Neurology, Molde Hospital, Molde, Norway
| | - LH Steffensen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - J Sømark
- Department of Neurology, Lillehammer Hospital, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - H Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | - TC Truelsen
- Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - L Wassvik
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - KL Ægidius
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - D Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - AH Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of neuromedicine and movement science, the Norwegian University of Science and Technology, Trondheim, Norway
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14
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Rønning OM, Carlsson M, Ihle-Hansen H, Aamodt AH, Tveiten A, Eltoft A, Fromm A, Ellekjær H, Kurz M. Monitoring following acute stroke should be improved. Tidsskr Nor Laegeforen 2022; 142:22-0401. [PMID: 36226425 DOI: 10.4045/tidsskr.22.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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15
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Hentzen NB, Ferretti MT, Santuccione A, Jaarsma J, de Visser M, Moro E, Hege Aamodt A, Arabia G, Aybeck S, Carvalho V, de Visser M, Teresa Ferretti M, Goudier R, Grisold W, Lebedeva ER, Jaarsma J, Matczack M, Magyari M, Judit Molnar M, Moro E, Rakusa M, Pajediene E, Tracy I, Vonck K. Mapping of European activities on the integration of sex and gender factors in neurology and neuroscience. Eur J Neurol 2022; 29:2572-2579. [PMID: 35673956 DOI: 10.1111/ene.15439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neurological disorders pose a profound unmet medical need for which new solutions are urgently needed. The consideration of both biological (sex) and socio-cultural (gender) differences between men and women is necessary to identify more efficacious, safer and tailored treatments. Approaches for putting sex and gender medicine into practice have gathered momentum across Europe, but it is currently unclear to what extent they have been implemented in the field of neurology and neuroscience. METHODS We mapped current activities in research, funding and education aimed at integrating sex and gender consideration in neuroscience and neurology in Europe. We examined and analyzed data gathered from (1) literature searches, (2) policy documents and reports by the European Commission and national funding agencies, (3) web-based searches, (4) "Web of Science", and (5) searches of project databases of funding agencies. An informative / non-systematic search was performed for sections on policies and funding, education, basic research, while a systematic literature and database review was conducted forquantitative analysis of research output and funded projects in terms of sex and gender analysis. RESULTS Our mapping shows that there is a growing interest and attention towards sex and gender consideration in neurological fields, both from funding agencies and researchers. However, most activities, especially for education, are limited to the individual motivation of researchers and are not organically built within curricula and strategic research priorities. DISCUSSION We recommend actions that might help increase the consideration of sex and gender specifically in the field of neuroscience and neurology.
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Affiliation(s)
| | | | | | - Joke Jaarsma
- EFNA - European Federation of Neurological Associations, Belgium
| | | | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute o Neuroscience, INSERM, Grenoble, France
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16
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Ratajczak-Tretel B, Tancin Lambert A, Hoie GA, Al-Ani R, Russell D, Atar D, Aamodt AH. Detection of atrial fibrillation in patients with cryptogenic stroke: The Nordic Atrial Fibrillation and Stroke (NOR-FIB) study - topline results. Europace 2022. [DOI: 10.1093/europace/euac053.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): NOR-FIB is an investigator driven academic study. 100 of 259 devices are supported by Medtronic.
BRT and ATL are recipients of a PhD grants from the South-Eastern Norway Regional Health Authority.
The study is supported by the research infrastructure of the European Cerebrovascular Research Infrastructure (ECRI).
Background
Cardioembolism due to occult atrial fibrillation (AF) is one of the common causes often identified by additional investigations in patients with cryptogenic stroke (CS). A large proportion of recurrent cerebral infarctions caused by AF can probably be prevented if more patients receive optimal cardiac monitoring after CS and TIA.
Purpose
The aim of the prospective observational multi-center NOR-FIB study was to detect and quantify AF in patients with cryptogenic stroke or TIA under continuous 12 months cardiac rhythm monitoring with an implantable cardiac monitor (ICM) and to possibly identify biomarkers predicting incident AF.
Methods
Patients with cryptogenic stroke and TIA diagnosed after state-of-the-art work-up had their ICM implanted by a stroke physician within 14 days after symptom onset. All patients were followed clinically and by rhythm monitoring for 12 months. AF was defined by detected atrial arrhythmia episodes ≥ 2 min, and these patients were considered for a change of their secondary prevention from antiplatelet drugs to oral anticoagulants (OAC).
Results
A total of 259 patients with cryptogenic stroke or TIA from 18 hospitals in Norway, Sweden and Denmark were included. After 12 months follow-up 74 (28.6 %) patients were diagnosed with paroxysmal AF, of which 91.9% were asymptomatic. Patients with AF had significantly higher mean age (72.6 vs 62.2, p<0.001), more severe stroke (median National Institute Stroke Scale Score on admission 2 vs 1, p 0.002) and higher pre-stroke median CHA2DS2-VASc score (3 vs 2, p<0.001) than patients without AF. Both hypertension and hyperlipidemia was more common in patients with AF. In 64 (86.5%) cases AF was detected early after index stroke, i.e., within the first two months of monitoring (mean 47.7 days + 52,1). Recurrent AF episodes were detected in 68 (91.9%) cases. Of the 74 AF patients, 72 (97.3%) were switched to OAC. Recurrent strokes during follow-up occurred in 2 AF patients (2.7 %) and in 9 non-AF patients (4.9 %).
Conclusion
AF was detected in 29% of all cryptogenic stroke/TIA patients. Most of the patients were asymptomatic for their arrhythmia, and would have gone undiagnosed without a continuous monitoring approach. Since most of the patients with detected AF were switched to OAC, the 12 months risk of recurrent stroke in this group was low. Prolonged cardiac rhythm monitoring with ICMs is an effective tool for diagnosing underlying asymptomatic AF in a patient population typically confined to a stroke unit.
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Affiliation(s)
| | - A Tancin Lambert
- Sykehuset Ostfold Kalnes, Department of Neurology, Sarpsborg, Norway
| | - GA Hoie
- Sykehuset Ostfold Kalnes, Department of Cardiology, Sarpsborg, Norway
| | - R Al-Ani
- Sykehuset Ostfold Kalnes, Department of Cardiology, Sarpsborg, Norway
| | - D Russell
- Oslo University Hospital Rikshospitalet, Department of Neurology, Oslo, Norway
| | - D Atar
- Oslo University Hospital Ulleval, Department of Cardiology, Oslo, Norway
| | - AH Aamodt
- Oslo University Hospital Rikshospitalet, Department of Neurology, Oslo, Norway
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17
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Enriquez BA, Tennøe B, Nome T, Gjertsen Ø, Nedregaard B, Sletteberg R, Skattør T, Sökjer M, Johansen H, Skagen KR, Skjelland M, Aamodt AH, Lund CG. Mekanisk trombektomi ved akutt hjerneinfarkt. Tidsskr Nor Laegeforen 2022; 142:21-0577. [PMID: 35510464 DOI: 10.4045/tidsskr.21.0577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mechanical thrombectomy is now the standard treatment for acute ischaemic stroke with occlusion of a carotid or intercranial artery. With occlusions of this type, thrombolytic treatment often has limited effect. The therapeutic outcome with the use of thrombectomy is time-dependent, and a personalised approach to indication is always necessary. To achieve the best possible results, the main prerequisites are good clinical procedures, an optimal patient pathway, high neuroradiological competence and coordinated, interdisciplinary teams.
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Affiliation(s)
| | - Bjørn Tennøe
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Terje Nome
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Øyvind Gjertsen
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Bård Nedregaard
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Ruth Sletteberg
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Thor Skattør
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | - Martin Sökjer
- Nevroradiologisk enhet, Oslo universitetssykehus, Rikshospitalet
| | | | | | - Mona Skjelland
- Nevrologisk avdeling, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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18
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Ratajczak‐Tretel B, Lambert AT, Atar D, Aamodt AH. Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines. Acta Neurol Scand 2022; 145:641-646. [PMID: 35146751 PMCID: PMC9303324 DOI: 10.1111/ane.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 01/25/2023]
Abstract
Background Empiric strategies for secondary prevention in cryptogenic stroke and cryptogenic TIA are lacking. The best therapy to prevent recurrence depends on the cause of stroke. Attempting a correct diagnosis is therefore the fundamental goal of stroke treatment. Further investigation into the source of embolism if suspected, and determination of the etiology, even if demanding, is the needed prerequisite for optimal secondary prevention and risk reduction. Aims This paper discusses evaluation and treatment of cryptogenic stroke in light of recent years’ clinical trials results and developments in cardiology and neuroradiology. No ethical approval was needed for this work. Results Cardioembolism due to paroxysmal atrial fibrillation, patent foramen ovale, or cardiomyopathy; occult atherosclerosis from unstable plaques and hypercoagulable conditions seem to be the most common underlying causes to be revealed by further investigations. Treatment of these conditions can reduce the stroke recurrence significantly. Conclusions An individual approach and targeted diagnostics using advanced medical technologies in selected patients, who may benefit from a tailored treatment regimen, can help reveal a probable cause in the majority of strokes and TIAs previously classified as cryptogenic.
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Affiliation(s)
- Barbara Ratajczak‐Tretel
- Department of Neurology Østfold Hospital Trust Grålum Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Anna Tancin Lambert
- Department of Neurology Østfold Hospital Trust Grålum Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Dan Atar
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Cardiology Oslo University Hospital Ullevål Oslo Norway
| | - Anne Hege Aamodt
- Department of Neurology Oslo University Hospital Rikshospitalet Oslo Norway
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19
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Abstract
Cerebral venous thrombosis (CVT) is a rare form of stroke that often affects younger age groups, especially reproductive age group females. CVT is a potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. Headache is the most common presenting symptom. However, a wide range of symptoms can be present and the symptom onset can be acute, subacute, or chronic. Neuroimaging is mandatory in cases where CVT is suspected. Both magnetic resonance venography and computed tomography venography can confirm a diagnosis of CVT. Anticoagulation with low-molecular-weight heparin is the mainstay of treatment. Intracranial hemorrhage is not considered a contraindication to the use of anticoagulants in CVT. Endovascular intervention is still controversial but can be a treatment option for patients with neurological deterioration or thrombus progression, despite the use of anticoagulation or with development of new or worsening intracerebral hemorrhage. Patients with CVT have an increased risk of recurrence of CVT and other types of venous thromboembolism. This review provides an overview of the epidemiology, diagnosis, and treatment of CVT in adults. Commentary about increased presentation of CVT in patients with coronavirus disease 2019 (COVID-19), or after immunization against COVID-19, is also provided.
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20
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Steiner T, Dichgans M, Norrving B, Aamodt AH, Berge E, Christensen H, Fuentes B, Khatri P, Korompoki E, Martí-Fabregas J, Quinn T, Toni D, Zedde M, Sacco S, Turc G. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J 2021; 6:CXXII-CXXXIV. [PMID: 34746429 DOI: 10.1177/23969873211024143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
The first European Stroke Organization (ESO) standard operating procedure (SOP) published in 2015 aimed at the implementation the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to provide evidence-based guidelines for stroke management. This second ESO-SOP is aiming at further increase of the practicability of ESO guidelines and its technical implications. Authors comprised of the members of the ESO guideline Board and ESO Executive Committee. The final document was agreed on by several internal reviews. The second SOP comprises of the following aspects: rational for the SOP, the introduction of expert consensus statements, types of guideline documents, structures involved and detailed description of the guideline preparation process, handling of financial and intellectual conflicts of interest (CoI), involvement of ESO members in the guideline process, review process, authorship and publication policy, updating of guidelines, cooperation with other societies, and dealing with falsified data. This second SOP supersedes the first SOP published in 2015.
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Affiliation(s)
- T Steiner
- Department of Neurology, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany.,Department of Neurology Hospital, Heidelberg University, Heidelberg, Germany
| | - M Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Norrving
- Department of Clinical Sciences Lund University Hospital and Lund University Departmnet of Neurology, Skane University Hospital, Lund, Sweden
| | - A H Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - E Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - H Christensen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - P Khatri
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - E Korompoki
- Division of Brain Science, Imperial College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Toni
- Departments of Neurological Sciences and Emergency, Unità di Trattamento Neurovascolare, University of Rome La Sapienza, Rome, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale - IRCCS, di Reggio Emilia, Reggio Emilia, Italy
| | - S Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - G Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
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21
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Aamodt AH, Taubøll E, Eichele T, Romundstad L, Sorteberg A, Wallace S, Fromm A, Raastad MF, Sand T, Skagen K, Eltoft A, Kefaloykos C, Frisvold SK, Nilsen KB, Carlsson M, Bråthen G, Bakke I, Horn MA, Wiedmann M, Tennøe B, Totland JA, Rønning OM, Kurz M, Storstein A. Brain monitoring in hospitals needs to be strengthened. Tidsskr Nor Laegeforen 2021; 141:21-0412. [PMID: 34726044 DOI: 10.4045/tidsskr.21.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Careful brain monitoring saves lives and is beneficial to patients' health. Nevertheless, Norway lacks guidelines for brain monitoring in hospitals.
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22
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Wiedmann M, Skattør T, Stray-Pedersen A, Romundstad L, Antal EA, Marthinsen PB, Sørvoll IH, Leiknes Ernstsen S, Lund CG, Holme PA, Johansen TO, Brunborg C, Aamodt AH, Schultz NH, Skagen K, Skjelland M. Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series. Front Neurol 2021; 12:721146. [PMID: 34393988 PMCID: PMC8363077 DOI: 10.3389/fneur.2021.721146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1–2 weeks earlier and developed a characteristic syndrome thereafter. The rapid progressive clinical course and high fatality rate of CVT in combination with thrombocytopenia in such a cluster and in otherwise healthy adults is a recent phenomenon. Cerebral autopsy findings were those of venous hemorrhagic infarctions and thrombi in dural venous sinuses, including thrombus material apparently rich in thrombocytes, leukocytes and fibrin. Vessel walls were free of inflammation. Extra-cerebral manifestations included leech-like thrombi in large veins, fibrin clots in small venules and scattered hemorrhages on skin and membranes. CVT with thrombocytopenia after adenovirus vectored COVID-19 vaccination is a new clinical syndrome that needs to be recognized by clinicians, is challenging to treat and seems associated with a high mortality rate.
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Affiliation(s)
- Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Thor Skattør
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University in Oslo, Oslo, Norway
| | - Luis Romundstad
- Department of Anesthesiology and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Ellen-Ann Antal
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Pål Bache Marthinsen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Hausberg Sørvoll
- Norwegian National Unit for Platelet Immunology at University Hospital of North Norway, Tromsø, Norway
| | - Siw Leiknes Ernstsen
- Norwegian National Unit for Platelet Immunology at University Hospital of North Norway, Tromsø, Norway
| | | | - Pål Andre Holme
- Faculty of Medicine, Institute of Clinical Medicine, University in Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Nina Haagenrud Schultz
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Department of Haematology, Akershus University Hospital, Lillestrøm, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Faculty of Medicine, Institute of Clinical Medicine, University in Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
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23
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Aamodt AH, Høgestøl EA, Popperud TH, Holter JC, Dyrhol-Riise AM, Tonby K, Stiksrud B, Quist-Paulsen E, Berge T, Barratt-Due A, Aukrust P, Heggelund L, Blennow K, Zetterberg H, Harbo HF. Blood neurofilament light concentration at admittance: a potential prognostic marker in COVID-19. J Neurol 2021; 268:3574-3583. [PMID: 33743046 PMCID: PMC7980743 DOI: 10.1007/s00415-021-10517-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022]
Abstract
Objective To test the hypotheses that blood biomarkers for nervous system injury, serum concentrations of neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAp) can serve as biomarkers for disease severity in COVID-19 patients. Methods Forty-seven inpatients with confirmed COVID-19 had blood samples drawn on admission for assessing serum biomarkers of CNS injury by Single molecule array (Simoa), NfL and GFAp. Concentrations of NfL and GFAp were analyzed in relation to symptoms, clinical signs, inflammatory biomarkers and clinical outcomes. We used multivariate linear models to test for differences in biomarker concentrations in the subgroups, accounting for confounding effects. Results In total, 21% (n = 10) of the patients were admitted to an intensive care unit, and the overall mortality rate was 13% (n = 6). Non-survivors had higher serum concentrations of NfL (p < 0.001) upon admission than patients who were discharged alive both in adjusted analyses (p = 2.6 × 10–7) and unadjusted analyses (p = 0.001). The concentrations of NfL in non-survivors increased over repeated measurements; whereas, the concentrations in survivors were stable. The GFAp concentration was also significantly higher in non-survivors than survivors (p = 0.02). Conclusion Increased concentrations of NfL and GFAp in COVID-19 patients on admission may indicate increased mortality risk. Measurement of blood biomarkers for nervous system injury can be useful to detect and monitor CNS injury in COVID-19.
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Affiliation(s)
- Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Einar August Høgestøl
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Jan Cato Holter
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Anne Ma Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Kristian Tonby
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Birgitte Stiksrud
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Tone Berge
- Department of Mechanical, Electronic and Chemical Engineering, Oslo Metropolitan University, Oslo, Norway.,Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway
| | - Andreas Barratt-Due
- Division of Emergencies and Critical Care, Oslo University HospitalRikshospitalet, Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Hanne Flinstad Harbo
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Grisold W, Moro E, Teresa Ferretti M, Hege Aamodt A, Arabia G, Lebedeva ER, Carvalho V, Rakusa M, Vonck K, Aybeck S, Hassan Mansour A, Goudier R, Giovannoni G, Jaarsma J, Judit Molnar M, Matczack M, Bassetti C, de Visser M. Gender issues during the times of COVID-19 pandemic. Eur J Neurol 2021; 28:e73-e77. [PMID: 33751757 PMCID: PMC8239897 DOI: 10.1111/ene.14815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble Institute of Neuroscience, Grenoble, France
| | | | | | - Gennarina Arabia
- Institute of Neurology, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Elena R Lebedeva
- International Headache Centre 'Europe-Asia', Ural State Medical University, Yekaterinburg, Russia
| | - Vanessa Carvalho
- Department of Neurology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Martin Rakusa
- Department of Neurology, Medical Research Department, University Medical Centre Maribor, Maribor, Slovenia
| | - Kristl Vonck
- Department of Neurology, Institute for Neuroscience, Ghent University Hospital, Ghent, Belgium
| | - Selma Aybeck
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Riadh Goudier
- Department of Neurology, Razi Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | | | - Claudio Bassetti
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Marianne de Visser
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Tveit L, Enriquez B, Tennøe B, Warsza B, Garstad LJ, Weisshaar M, Aamodt AH. Cerebral venous thrombosis after COVID-19. Tidsskr Nor Laegeforen 2020; 140:20-0563. [PMID: 33322869 DOI: 10.4045/tidsskr.20.0563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is emerging evidence of an increased risk of venous thromboembolism as well as several reports of cerebral venous thrombosis in COVID-19. CASE PRESENTATION A previously healthy man in his fifties was admitted due to sudden confusion and reduced consciousness. One month earlier the patient had symptoms with headache, fever, dry cough, vomiting and diarrhoea and reduced sense of taste and smell. He was diagnosed with COVID-19 and the symptoms were mainly resolved within three weeks. On admission the patient was disorientated with aphasia. Brain imaging revealed a haemorrhagic infarction in the left temporal lobe due to thrombosis of the left transverse sinus and low-molecular weight heparin was instituted. On follow-up four months later, there was clinical improvement with only slight problems with short term memory and concentration. INTERPRETATION This case illustrates the risk of serious neurological complications due to cerebral venous thrombosis in COVID-19.
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26
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Stubberud A, Linde M, Brenner E, Heier M, Olsen A, Aamodt AH, Gravdahl GB, Tronvik E. Self‐administered biofeedback treatment app for pediatric migraine: A randomized pilot study. Brain Behav 2020. [PMCID: PMC7882181 DOI: 10.1002/brb3.1974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To investigate the effect size, safety, and tolerability of a therapist‐independent biofeedback treatment app among adolescent with migraine. Materials and Methods This was a prospective, 3:1 ratio randomized, sham‐controlled, double‐blind, pilot study with 16 adolescents diagnosed with migraine randomized to eight weeks of biofeedback treatment (n = 12) or sham biofeedback (n = 4), carried out at two university hospitals in Norway. The prespecified and primary objective of the study was to observe changes in outcomes within the active treatment group. The sham control group was included in a minor ratio primarily to evaluate its feasibility. The primary outcome was change in headache frequency. A modified intention to treat analysis was performed, including participants completing at least seven biofeedback sessions in weeks 1–4 (n = 12 vs. n = 4) and weeks 5–8 (n = 7 vs. n = 2). Results Adherence was poor with 40% (136/336) of planned biofeedback sessions completed during weeks 5–8. Within the biofeedback group, a not statistically significant reduction in headache frequency was observed at weeks 1–4 (2.92 days/month, 95% CI −1.00 to 6.84, p = .145) and weeks 5–8 (1.85 days/month, 95% CI −2.01 to 5.72, p = .395). The biofeedback group experienced a median of one fewer headache days/month versus sham that did not reach significance (95% CI −4.0 to 9.0, p = .760). Conclusions We observed a small reduction in headache frequency in the active treatment group. Findings were likely undermined by low adherence and underpowered analyses but indicate that a therapist‐independent biofeedback treatment app has the potential to be an effective, tolerable, and inexpensive treatment option.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
| | - Mattias Linde
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Eiliv Brenner
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Martin Heier
- Department of Clinical Neuroscience for ChildrenOslo University HospitalOsloNorway
| | - Alexander Olsen
- Department of PsychologyNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs HospitalTrondheimNorway
| | | | - Gøril B. Gravdahl
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Erling Tronvik
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
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27
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Kurz MW, Ospel JM, Advani R, Sandset EC, Aamodt AH, Tennøe B, Ersdal HL, Fjetland L, Ajmi S, Kurz KD, Goyal M. Simulation Methods in Acute Stroke Treatment: Current State of Affairs and Implications. Stroke 2020; 51:1978-1982. [PMID: 32568639 DOI: 10.1161/strokeaha.119.026732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin W Kurz
- Department of Neurology (M.W.K., S.A.), Stavanger University Hospital, Norway.,Neuroscience Research Group (M.W.K., R.A., S.A.), Stavanger University Hospital, Norway.,Department of Clinical Science, University of Bergen, Norway (M.W.K.)
| | - Johanna M Ospel
- Department of Clinical Neurosciences (J.M.O.), University of Calgary, Alberta, Canada.,Department of Radiology, Universitätsspital Basel, Switzerland (J.M.O.)
| | - Rajiv Advani
- Neuroscience Research Group (M.W.K., R.A., S.A.), Stavanger University Hospital, Norway.,Department of Neurology, Stroke Unit (R.A., E.C.S.), Oslo University Hospital, Norway
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit (R.A., E.C.S.), Oslo University Hospital, Norway.,Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway (E.C.S.)
| | - Anne Hege Aamodt
- Department of Neurology (A.H.A.), Oslo University Hospital, Norway
| | - Bjørn Tennøe
- Department of Radiology and Nuclear Medicine, Division of Diagnostics and Intervention (B.T.), Oslo University Hospital, Norway
| | - Hege L Ersdal
- Department of Anesthesiology and Intensive Care (H.L.E.), Stavanger University Hospital, Norway.,Faculty of Health Sciences (H.L.E.), University of Stavanger, Norway
| | - Lars Fjetland
- Department of Radiology (L.F., K.D.K.), Stavanger University Hospital, Norway.,SMIL Stavanger Medical Imaging Laboratory (L.F., K.D.K.), Stavanger University Hospital, Norway
| | - Soffien Ajmi
- Department of Neurology (M.W.K., S.A.), Stavanger University Hospital, Norway.,Neuroscience Research Group (M.W.K., R.A., S.A.), Stavanger University Hospital, Norway
| | - Kathinka D Kurz
- Department of Radiology (L.F., K.D.K.), Stavanger University Hospital, Norway.,SMIL Stavanger Medical Imaging Laboratory (L.F., K.D.K.), Stavanger University Hospital, Norway.,Department of Electrical and Computer Engineering (K.D.K.), University of Stavanger, Norway
| | - Mayank Goyal
- Diagnostic Imaging (M.G.), University of Calgary, Alberta, Canada.,Department of Clinical Neurosciences (M.G.), University of Calgary, Alberta, Canada
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28
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Skagen K, Aamodt AH, Enriquez B, Skjelland M. Too little knowledge about blood pressure in cases of ischaemic stroke. Tidsskr Nor Laegeforen 2020; 140:20-0323. [PMID: 32549003 DOI: 10.4045/tidsskr.20.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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30
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Aamodt AH, Bjørk MH, Tronvik EA, Buanes EA, Stovner LJ, Atar D. Gir ACE-hemmere og angiotensinreseptorantagonister økt risiko for alvorlig covid-19? Tidsskriftet 2020; 140:20-0411. [DOI: 10.4045/tidsskr.20.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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31
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Stien R, Aamodt AH, Brean A. Bjarne Ranheim. Tidsskriftet 2020. [DOI: 10.4045/tidsskr.20.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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32
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Rønning OM, Logallo N, Thommessen B, Tobro H, Novotny V, Kvistad CE, Aamodt AH, Næss H, Waje-Andreassen U, Thomassen L. Tenecteplase Versus Alteplase Between 3 and 4.5 Hours in Low National Institutes of Health Stroke Scale. Stroke 2019; 50:498-500. [PMID: 30602354 DOI: 10.1161/strokeaha.118.024223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Thrombolysis with alteplase has beneficial effect on outcome and is safe within 4.5 hours. The present study compares the efficacy and safety of tenecteplase and alteplase in patients treated 3 to 4.5 hours after ischemic stroke. Methods- The data are from a prespecified substudy of patients included in The NOR-TEST (Norwegian Tenecteplase Stroke Trial), a randomized control trial comparing tenecteplase with alteplase. Results- The median admission National Institutes of Health Stroke Scale for this study population was 3 (interquartile range, 2-6). In the intention-to-treat analysis, 57% of patients that received tenecteplase and 53% of patients that received alteplase reached good functional outcome (modified Rankin Scale score of 0-1) at 3 months (odds ratio, 1.19; 95% CI, 0.68-2.10). The rates of intracranial hemorrhage in the first 48 hours were 5.7% in the tenecteplase group and 6.7% in the alteplase group (odds ratio, 0.84; 95% CI, 0.26-2.70). At 3 months, mortality was 5.7% and 4.5%, respectively. After excluding stroke mimics and patients with modified Rankin Scale score of >1 before stroke, the proportion of patients with good functional outcome was 61% in the tenecteplase group and 57% in the alteplase group (odds ratio, 1.24; 95% CI, 0.65-2.37). Conclusions- Tenecteplase is at least as effective as alteplase to achieve a good clinical outcome in patients with mild stroke treated between 3 and 4.5 hours after ischemic stroke. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01949948.
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Affiliation(s)
- Ole Morten Rønning
- From the Division of Medicine, Department of Neurology, Akershus University Hospital, Lorenskog, Norway (O.M.R., B.T).,Institute of Clinical Medicine, University of Oslo, Norway (O.M.R.)
| | - Nicola Logallo
- Department of Neurosurgery (N.L.), Haukeland University Hospital, Bergen, Norway
| | - Bente Thommessen
- From the Division of Medicine, Department of Neurology, Akershus University Hospital, Lorenskog, Norway (O.M.R., B.T)
| | - Håkon Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway (H.T.)
| | - Vojtech Novotny
- Department of Neurology (V.N., C.E.K., H.N., U.W.-A., L.T.), Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Norway (V.N., C.E.K., H.N., L.T.)
| | - Christopher E Kvistad
- Department of Neurology (V.N., C.E.K., H.N., U.W.-A., L.T.), Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Norway (V.N., C.E.K., H.N., L.T.)
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Norway (A.H.A.)
| | - Halvor Næss
- Department of Neurology (V.N., C.E.K., H.N., U.W.-A., L.T.), Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Norway (V.N., C.E.K., H.N., L.T.).,Center for Age-Related Medicine, Stavanger University Hospital, Norway (H.N.)
| | - Ulrike Waje-Andreassen
- Department of Neurology (V.N., C.E.K., H.N., U.W.-A., L.T.), Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Neurology (V.N., C.E.K., H.N., U.W.-A., L.T.), Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Norway (V.N., C.E.K., H.N., L.T.)
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Ljøstad U, Eldøen G, Goplen FK, Aamodt AH, Mygland Å. Assessment in cases of acute dizziness. Tidsskr Nor Laegeforen 2019; 139:18-0958. [PMID: 31140257 DOI: 10.4045/tidsskr.18.0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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34
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Aamodt AH, Bjørk MH, Alstadhaug KB, Eldøen G, Dueland AN, Poole T, Hagen K, Vetvik KG, Ofte HK, Sønnervik J, Kristoffersen ES, Winsvold BS, Lundqvist C, Sagabråten SO. Practical management of headache. Tidsskr Nor Laegeforen 2019; 139:18-0837. [PMID: 30969051 DOI: 10.4045/tidsskr.18.0837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ratajczak-Tretel B, Lambert AT, Johansen H, Halvorsen B, Bjerkeli V, Russell D, Sandset EC, Ihle-Hansen H, Eriksen E, Næss H, Novotny V, Khanevski AN, Truelsen TC, Idicula T, Ægidius KL, Tobro H, Krogseth SB, Ihle-Hansen H, Hagberg G, Kruuse C, Arntzen K, Bakkejord GK, Villseth M, Nakstad I, Eldøen G, Shafiq R, Gulsvik A, Kurz M, Rezai M, Sømark J, Tingvoll SH, Jonassen C, Ingebrigtsen S, Steffensen LH, Kremer C, Atar D, Aamodt AH. Atrial fibrillation in cryptogenic stroke and transient ischaemic attack - The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design. Eur Stroke J 2019; 4:172-180. [PMID: 31259265 DOI: 10.1177/2396987319837089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose Paroxysmal atrial fibrillation is often suspected as a probable cause of cryptogenic stroke. Continuous long-term ECG monitoring using insertable cardiac monitors is a clinically effective technique to screen for atrial fibrillation and superior to conventional follow-up in cryptogenic stroke. However, more studies are needed to identify factors which can help selecting patients with the highest possibility of detecting atrial fibrillation with prolonged rhythm monitoring. The clinical relevance of short-term atrial fibrillation, the need for medical intervention and the evaluation as to whether intervention results in improved clinical outcomes should be assessed. Method The Nordic Atrial Fibrillation and Stroke Study is an international, multicentre, prospective, observational trial evaluating the occurrence of occult atrial fibrillation in cryptogenic stroke and transient ischaemic attack. Patients with cryptogenic stroke or transient ischaemic attack from the Nordic countries are included and will have the Reveal LINQ® Insertable cardiac monitor system implanted for 12 months for atrial fibrillation detection. Biomarkers which can be used as predictors for atrial fibrillation and may identify patients, who could derive the most clinical benefit from the detection of atrial fibrillation by prolonged monitoring, are being studied. Conclusion The primary endpoint is atrial fibrillation burden within 12 months of continuous rhythm monitoring. Secondary endpoints are atrial fibrillation burden within six months, levels of biomarkers predicting atrial fibrillation, CHA2DS2-VASc score, incidence of recurrent stroke or transient ischaemic attack, use of anticoagulation and antiarrhythmic drugs, and quality of life measurements. The clinical follow-up period is 12 months. The study started in 2017 and the completion is expected at the end of 2020.
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Affiliation(s)
- Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Eriksen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Vojtech Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Thomas C Truelsen
- Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Titto Idicula
- Department of Neurology, St. Olav University Hospital, Trondheim, Norway
| | - Karen L Ægidius
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Håkon Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | - Siv B Krogseth
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Guri Hagberg
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Christina Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Maja Villseth
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ingvild Nakstad
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Raheel Shafiq
- Department of Neurology, Molde Hospital, Molde, Norway
| | - Anne Gulsvik
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Martin Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Mehdi Rezai
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jesper Sømark
- Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | | | - Christine Jonassen
- Center of Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway.,Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | | | | | - Christine Kremer
- Department of Neurology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology B, Oslo University Hospital, Ullevål, Oslo, Norway
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Almekhlafi MA, Kunz WG, Menon BK, McTaggart RA, Jayaraman MV, Baxter BW, Heck D, Frei D, Derdeyn CP, Takagi T, Aamodt AH, Fragata IMR, Hill MD, Demchuk AM, Goyal M. Imaging of Patients with Suspected Large-Vessel Occlusion at Primary Stroke Centers: Available Modalities and a Suggested Approach. AJNR Am J Neuroradiol 2019; 40:396-400. [PMID: 30705072 DOI: 10.3174/ajnr.a5971] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/06/2018] [Indexed: 12/24/2022]
Abstract
The overwhelming benefit of endovascular therapy in patients with large-vessel occlusions suggests that more patients will be screened than treated. Some of those patients will be evaluated first at primary stroke centers; this type of evaluation calls for standardizing the imaging approach to minimize delays in assessing, transferring, and treating these patients. Here, we propose that CT angiography (performed at the same time as head CT) should be the minimum imaging approach for all patients with stroke with suspected large-vessel occlusion presenting to primary stroke centers. We discuss some of the implications of this approach and how to facilitate them.
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Affiliation(s)
- M A Almekhlafi
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - W G Kunz
- Department of Radiology (W.G.K.), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - B K Menon
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - R A McTaggart
- Departments of Neurology, Diagnostic Imaging, and Neurosurgery (R.A.M., M.V.J.), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M V Jayaraman
- Departments of Neurology, Diagnostic Imaging, and Neurosurgery (R.A.M., M.V.J.), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - B W Baxter
- Department of Radiology (B.W.B.), Erlanger Medical Center, Chattanooga, Tennessee
| | - D Heck
- Department of Radiology (D.H.), Forsyth Medical Center, Winston Salem, North Carolina
| | - D Frei
- Swedish Medical Center (D.F.), Denver, Colorado
| | - C P Derdeyn
- Department of Radiology (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - T Takagi
- Department of Neurosurgery (T.T.), Hyogo College of Medicine, Nishinomiya, Hyögo, Japan
| | - A H Aamodt
- Department of Neurology (A.H.A.), Oslo University Hospital, Oslo, Norway
| | - I M R Fragata
- Department of Neuroradiology (I.M.R.F.), Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - M D Hill
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - A M Demchuk
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - M Goyal
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
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Aamodt AH, Kurz M, Jacobsen EA, Totland JA, Rønning OM, Thomassen L, Lund CG, Næss H. Indications for thrombectomy. Tidsskr Nor Laegeforen 2018; 138:18-0771. [PMID: 30378416 DOI: 10.4045/tidsskr.18.0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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39
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Skarpengland T, Skjelland M, Kong XY, Skagen K, Holm S, Otterdal K, Dahl CP, Krohg-Sørensen K, Sagen EL, Bjerkeli V, Aamodt AH, Abbas A, Gregersen I, Aukrust P, Halvorsen B, Dahl TB. Increased Levels of Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 in Ischemic Stroke and Transient Ischemic Attack. J Am Heart Assoc 2018; 7:JAHA.117.006479. [PMID: 29330254 PMCID: PMC5850141 DOI: 10.1161/jaha.117.006479] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Soluble lectin‐like oxidized low‐density lipoprotein receptor‐1 (sLOX‐1) has been shown to be increased in patients with acute ischemic stroke. Here, we evaluated plasma sLOX‐1 levels and vascular carotid plaque LOX‐1 (ie, OLR1) gene expression in patients with ischemic stroke and transient ischemic attack (TIA) with particular focus on their relation to time since symptom onset. Methods and Results Plasma sLOX‐1 (n=232) and carotid plaque OLR1 gene expression (n=146) were evaluated in patients who were referred to evaluation for carotid endarterectomy, as well as in healthy control plasma (n=81). Patients were categorized according to presence of acute ischemic stroke or transient ischemic attack (n=35) ≤7 days, >7 days ≤3 months (n=90), >3 months (n=40), or no reported symptoms before study inclusion (n=67). Our major findings were the following: (1) Patients with carotid atherosclerosis had increased plasma sLOX‐1 levels as compared with controls. (2) Plaque OLR1 mRNA levels were increased in carotid plaques (n=146) compared with nonatherosclerotic vessels (ie, common iliac arteries of organ donors, n=10). (3) There were no differences in sLOX plasma levels or OLR1 gene expression when analyzed according to the time since relevant cerebral ischemic symptoms. (4) Also patients with severe carotid atherosclerosis without any previous ischemic events had raised sLOX‐1 levels. (5) Immunostaining showed colocalization between LOX‐1 and macrophages within the carotid plaques. (6) Also patients with acute stroke (within 7 days) caused by atrial fibrillation (n=22) had comparable raised sLOX‐1 levels. Conclusions sLOX‐1 levels are elevated in patients with ischemic stroke and transient ischemic attack independent of cause and time since the ischemic event.
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Affiliation(s)
- Tonje Skarpengland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kari Otterdal
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Christen P Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway
| | - Ellen L Sagen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway .,Department of Microbiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
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Winsvold BS, Marvik A, Zwart JA, Aamodt AH. Migraine and stroke. Tidsskriftet 2018; 138:17-0347. [DOI: 10.4045/tidsskr.17.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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41
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Aamodt AH. Rett dosering av mobilisering. Tidsskriftet 2018; 138:18-0769. [DOI: 10.4045/tidsskr.18.0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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42
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Kvistad CE, Thomassen L, Aamodt AH, Logallo N. Tenecteplase ved akutt hjerneinfarkt. Tidsskriftet 2018; 138:17-0992. [DOI: 10.4045/tidsskr.17.0992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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43
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Logallo N, Novotny V, Assmus J, Kvistad CE, Alteheld L, Rønning OM, Thommessen B, Amthor KF, Ihle-Hansen H, Kurz M, Tobro H, Kaur K, Stankiewicz M, Carlsson M, Morsund Å, Idicula T, Aamodt AH, Lund C, Næss H, Waje-Andreassen U, Thomassen L. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol 2017; 16:781-788. [DOI: 10.1016/s1474-4422(17)30253-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022]
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Abstract
As clinic-based studies show an association between headache and both high and low levels of haemoglobin, we analysed this relationship in a population-based cross-sectional study (the HUNT Study). A total of 2385 women aged 20-55 years responded to a headache questionnaire and gave blood samples for measuring haemoglobin and ferritin. In the multivariate analyses, adjusting for age and education, there was a linear trend of decreasing prevalence of headache ( P = 0.02) and migraine ( P = 0.01) with decreasing haemoglobin. In particular, migraine was less likely among women with low haemoglobin (values < 11.5 g/dl) (odds ratio 0.4, confidence interval 0.2, 0.9). There was no correlation between headache prevalence and ferritin. The present findings may be relevant for the headache reported in polycythaemia and chronic altitude sickness.
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Affiliation(s)
- A H Aamodt
- Norwegian National Headache Centre, Trondheim University Hospital, Trondheim, Norway.
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45
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Johansen H, Rutherford OCW, Aamodt AH, Russell D, Atar D, Ghanima W. Nye antikoagulasjonsmidler i kombinasjon med platehemmere. Tidsskriftet 2016; 136:1543-1546. [DOI: 10.4045/tidsskr.15.1356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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46
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Lorentzen AO, Nome T, Bakke SJ, Scheie D, Stenset V, Aamodt AH. Cerebral foreign body reaction after carotid aneurysm stenting. Interv Neuroradiol 2015; 22:53-7. [PMID: 26510943 DOI: 10.1177/1591019915609171] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization--a multifocal inflammation spread out through the white matter of one hemisphere without hemorrhage or ischemic changes.
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Affiliation(s)
- Anastasia Orlova Lorentzen
- Department of Radiology, Østfold Hospital Trust HF, Norway Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Terje Nome
- Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway
| | - Søren Jacob Bakke
- Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Vidar Stenset
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
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Jusufovic M, Lygren A, Aamodt AH, Nedregaard B, Kerty E. Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy. BMC Neurol 2015; 15:151. [PMID: 26357841 PMCID: PMC4566418 DOI: 10.1186/s12883-015-0409-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 08/14/2015] [Indexed: 11/29/2022] Open
Abstract
Background Vascular damage in the central hand knob area can mimic peripheral motor nerve deficits. Case presentation We describe the case of a woman presenting with apparent peripheral neuropathy. Brain magnetic resonance imaging and computed tomography angiography revealed an infarct in the precentral hand knob area, with significant stenosis in the right proximal middle cerebral artery trunk. Subsequent 3-Tesla magnetic resonance imaging of the brain suggested cerebral angiitis. The patient experienced improved hand function following combined glucocorticoid and cyclophosphamide treatment. Conclusion Vascular damage in the hand knob area should be considered when evaluating peripheral motor nerve deficits in the presence of normal nerve conduction velocities. The diagnosis of cerebral angiitis remains a major challenge for clinicians.
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Affiliation(s)
| | - Astrid Lygren
- Dept of Neurology, Oslo University Hospital, Oslo, Norway. .,Dept of Psychiatry, Akershus University Hospital, Lørenskog, Norway.
| | | | | | - Emilia Kerty
- Dept of Neurology, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Nacu A, Kvistad CE, Logallo N, Naess H, Waje-Andreassen U, Aamodt AH, Solhoff R, Lund C, Tobro H, Rønning OM, Salvesen R, Idicula TT, Thomassen L. A pragmatic approach to sonothrombolysis in acute ischaemic stroke: the Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS). BMC Neurol 2015; 15:110. [PMID: 26162826 PMCID: PMC4499181 DOI: 10.1186/s12883-015-0359-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasound accelerates thrombolysis with tPA (sonothrombolysis). Ultrasound in the absence of tPA also accelerates clot break-up (sonolysis). Adding intravenous gaseous microbubbles may potentiate the effect of ultrasound in both sonothrombolysis and sonolysis. The Norwegian Sonothrombolysis in Acute Stroke Study aims in a pragmatic approach to assess the effect and safety of contrast enhanced ultrasound treatment in unselected acute ischaemic stroke patients. METHODS/DESIGN Acute ischaemic stroke patients ≥ 18 years, with or without visible arterial occlusion on computed tomography angiography (CTA) and treatable ≤ 4(½) hours after symptom onset, are included in NOR-SASS. NOR-SASS is superimposed on a separate trial randomising patients with acute ischemic stroke to either tenecteplase or alteplase (The Norwegian Tenecteplase Stroke Trial NOR-TEST). The NOR-SASS trial has two arms: 1) the thrombolysis-arms (NOR-SASS A and B) includes patients given intravenous thrombolysis (tenecteplase or alteplase), and 2) the no-thrombolysis-arm (NOR-SASS C) includes patients with contraindications to thrombolysis. First step randomisation of NOR-SASS A is embedded in NOR-TEST as a 1:1 randomisation to either tenecteplase or alteplase. Second step NOR-SASS randomisation is 1:1 to either contrast enhanced sonothrombolysis (CEST) or sham CEST. Randomisation in NOR-SASS B (routine alteplase group) is 1:1 to either CEST or sham CEST. Randomisation of NOR-SASS C is 1:1 to either contrast enhanced sonolysis (CES) or sham CES. Ultrasound is given for one hour using a 2-MHz pulsed-wave diagnostic ultrasound probe. Microbubble contrast (SonoVue®) is given as a continuous infusion for ~30 min. Recanalisation is assessed at 60 min after start of CEST/CES. Magnetic resonance imaging and angiography is performed after 24 h of stroke onset. Primary study endpoints are 1) major neurological improvement measured with NIHSS score at 24 h and 2) favourable functional outcome defined as mRS 0-1 at 90 days. DISCUSSION NOR-SASS is the first randomised controlled trial designed to test the superiority of contrast enhanced ultrasound treatment given ≤ 4(½) hours after stroke onset in an unselected acute ischaemic stroke population eligible or not eligible for intravenous thrombolysis, with or without a defined arterial occlusion on CTA. If a positive effect and safety can be proven, contrast enhanced ultrasound treatment will be an option for all acute ischaemic stroke patients. EudraCT No 201200032341; www.clinicaltrials.gov NCT01949961.
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Affiliation(s)
- Aliona Nacu
- Department of Neurology, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Christopher E Kvistad
- Department of Neurology, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Nicola Logallo
- Department of Neurology, Haukeland University Hospital, N-5021, Bergen, Norway.
| | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway. .,Centre for age-related medicine, Stavanger University Hospital, Stavanger, Norway.
| | | | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Ragnar Solhoff
- Department of Neurology, Arendal Hospital, Arendal, Norway.
| | - Christian Lund
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Håkon Tobro
- Department of Neurology, Skien Hospital, Skien, Norway.
| | - Ole Morten Rønning
- Department of Neuroly, Akershus University Hospital, Nordbyhagen, Norway.
| | - Rolf Salvesen
- Department of Neurology, Bodø Hospital, Bodo, Norway.
| | - Titto T Idicula
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway.
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Logallo N, Kvistad CE, Nacu A, Naess H, Waje-Andreassen U, Asmuss J, Aamodt AH, Lund C, Kurz MW, Rønning OM, Salvesen R, Idicula TT, Thomassen L. The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke. BMC Neurol 2014; 14:106. [PMID: 24886064 PMCID: PMC4029902 DOI: 10.1186/1471-2377-14-106] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/23/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. METHODS/DESIGN NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4 mg/kg (single bolus) as compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted <4½ hours after symptoms onset; b) admitted <4½ hours after awakening with stroke symptoms c) receiving bridging therapy before embolectomy.Randomisation tenecteplase:alteplase is 1:1. The primary study endpoint is favourable functional outcome defined as modified Rankin Scale 0-1 at 90 days. Secondary study endpoints are: 1) haemorrhagic transformation (haemorrhagic infarct/haematoma); 2) symptomatic cerebral haemorrhage on CT 24-48 hours; 3) major neurological improvement at 24 hours; 4) recanalisation at 24-36 hours; 5) death. DISCUSSION NOR-TEST may establish a novel approach to acute ischaemic stroke treatment. A positive result will lead to a more effective, safer and easier treatment for all acute ischaemic stroke pasients.NOR-TEST is reviewed and approved by the Regional Committee for Medical and Health Research Ethics (2011/2435), and The Norwegian Medicines Agency (12/01402). NOR-TEST is registered with EudraCT No 2011-005793-33 and in ClinicalTrials.gov (NCT01949948).
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Affiliation(s)
- Nicola Logallo
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christopher E Kvistad
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Aliona Nacu
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Halvor Naess
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Ulrike Waje-Andreassen
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jörg Asmuss
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Christian Lund
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Ole Morten Rønning
- Medical Division, Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Rolf Salvesen
- Department of Neurology, Nordland Hospital, Bodo, Norway
- Department of Clinical Medicine, University of Tromso, Norway
| | - Titto T Idicula
- Department of Neurology, St.Olav Hospital, Trondheim, Norway
| | - Lars Thomassen
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Pihlstrøm L, Nedregaard B, Krossnes B, Aamodt AH. [Septic embolus]. Tidsskr Nor Laegeforen 2014; 134:945. [PMID: 24828721 DOI: 10.4045/tidsskr.13.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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